FEDERAL FINANCIAL AID WORK-STUDY PROGRAM
APPLICATION
ID #
A
Name ___________________________________________________________
(Last Name)
(First Name)
(MI)
Your application tells your potential employer important information about you and makes a first impression. Be
clear and accurate. Please print in ink.
Campus attending:
 Florissant Valley
 Forest Park
 Meramec
 Wildwood
Term: ______________ Year: _________
Address: _______________________________________________________________________________________________
Street
Apt. No./P.O. Box No.
City
State
Zip Code
Home Phone: ____________________________________ Major: _________________________________________________
Number semesters attended: __________________ Expected graduation date: __________________
Give a brief statement concerning your reasons for wanting a part-time job: ______________________________________________
______________________________________________________________________________________________________
EDUCATION INFORMATION
High School Graduate:
 Yes
 No
GED:
 Yes
 No
Where? __________________________________________________
Name of high school attended: _______________________________________________________________________________
Other colleges attended: ___________________________________________________________________________________
JOB INFORMATION
Type of work desired (circle all those that are of interest to you):
Computer Lab
Print Shop
Library
Math Dept.
Communications
Athletics
Childcare
Science Labs
Arts/Humanities
Reading Dept.
Admissions/Registration/Financial Aid
Campus Life
Media Services
Radio Station
When are you available to start work? _________________________________________________________________________
What time of day or evening works best in your schedule? __________________________________________________________
(continued on reverse side)
St. Louis Community College is committed to non-discrimination and equal opportunities in its admissions, educational programs, activities and employment
regardless of race, color, creed, religion, sex, sexual orientation, national origin, ancestry, age, disability, genetic information or status as a disabled or Vietnam-era
veteran and shall take action necessary to ensure non-discrimination.
For information or concerns relating to discrimination matters, contact the following: for matters relating to disabilities, contact Section 504/Title II Coordinator
Donna Dare at 314-539-5285; for matters relating to sex discrimination, contact Title IX Coordinator Pam McIntyre at 314-984-7763.
FEDERAL FINANCIAL AID WORK-STUDY PROGRAM
APPLICATION
(side 2)
ID #
A
Name ___________________________________________________________
(Last Name)
(First Name)
(MI)
SKILLS
Typing speed: ____________
Computer Experience:
 Yes
 No
Office experience: ________________________________________________________________________________________
Customer service experience: _______________________________________________________________________________
Other skills/experience: ____________________________________________________________________________________
Are you currently employed?
 Yes
 No
If yes, where? ________________________________________________
Have you ever been convicted of a felony or misdemeanor (other than a traffic violation)?
 Yes
 No
If yes, give details: _________________________________________________________________________________________
EMPLOYMENT HISTORY
List work and/or volunteer experience. Start with present or most recent and list in reverse order.
Dates (From-To)
Name of Company
Address City/State
Telephone
Your position
PERSONAL REFERENCES
Name
City/State
Telephone
Relationship to you
CLASS SCHEDULE (HOURS)
Please check current semester:  Fall  Spring
 Summer
Monday
Tuesday
Wednesday
Thursday
Friday
Is there any information you would like to add?
______________________________________________________________________________________________________
Signature: _____________________________________________________ Date: ____________________________________
— OFFICE USE ONLY —
FWS Eligibility: _________________________
Fall
Spring
Summer
Hire Date: ________________
FAA Initials: ________________
100180 11/14